The Impact of Diagnostic Delay on Wound Healing—A Cohort Study in a Primary Care Setting

Abstract

The impact of diagnostic delays on wound healing has not been investigated in the primary care setting. The aim of this cohort study was to examine how diagnostic delays influence the healing of a chronic wound. This is a retrospective study on patients who were assessed by a specialized wound care team of a primary health care unit, aiming to reduce diagnostic and treatment delays among patients with chronic wounds. The data consist of 197 consecutive patients who had their first appointment with the wound care team in 2016. Patients whose wounds had appeared less than one year prior to the diagnosis (n = 182) were included in the analyses. Primary and secondary outcome measures: The primary outcome measure was wound healing and its association with a diagnostic delay. Delays were categorized into three groups by the date of the diagnosis: (1) less than 4 weeks (n = 33), (2) 4–12 weeks (n = 94) and (3) over 12 weeks (n = 55) after the appearance of the wound. A diagnostic delay had a significant effect on the wound healing time. Wounds had a shorter healing time if they were diagnosed early. The cumulative healing rate at 12 weeks was 54.5% in Group 1, 17.0% in Group 2 and 0% in Group 3. And 62.5% of the arterial ulcers and 47.8% of the diabetic ulcers were diagnosed within 4–12 weeks. Most of the venous leg ulcers were diagnosed within 4–12 weeks (54.2%). Our data clearly show that the earlier the diagnosis, the shorter the healing time in a primary care setting. The wounds that were diagnosed the earliest were mainly post-traumatic and venous leg ulcers. On the other hand, wounds requiring prompt diagnosis, such as diabetic foot ulcers and arterial ulcers, were not included in the group of early diagnosis. We conclude that a speedy diagnosis and aetiology-driven treatment of a wound has a direct impact on the wound healing time. Therefore, it is essential to improve the diagnostic pathways from the onset of the wound, starting from the primary care setting.